Coins are miniature works of art. Since portraits of prominent individuals have graced coins for millennia, images forged in precious metals in the distant past can represent disease even now. Indeed, the earliest artistic depictions of disorders such as goiter and trichoepithelioma were on ancient Greek, Roman, and Parthian coins.1 Portraits of royals have long adorned money, permitting evaluation of inherited diseases hundreds or thousands of years later, since royal families through the ages have extensively inbred to maintain the “purity” of their lines. Ironically, this practice instead fostered anomalies and disease, as exemplified by the Royal House of Habsburg, which dominated Europe from the 1400s to 1700’s (and less influentially to the early 1900’s), through Spanish and Austrian/German lines. Among other maladies, the Habsburgs exhibited prominent mandibular prognathism, known as the ‘Habsburg jaw’ or ‘lantern jaw’, over many centuries.1 ‘Lantern jaw’ bears no relation to the lantern-like mouth of sea urchins described by Aristotle, but instead to the jutting base of lanterns common in the Habsburg era. Indeed, those affected have a protruding lower jaw and resultant underbite.

Extreme mandibular prognathism can be seen in Holy Roman Emperor Leopold I (1640-1705), whose profile dominates the illustrated silver Austrian 3 Kreuzer coin of 1670. In fact, this image contributed to his unflattering moniker ‘Leopold the Hogmouth’. The humped nose (‘Habsburg nose’) and enlarged lower lip (‘Habsburg lip’) are also evident. On coins of later dates, these traits become more prominent for Leopold and other Habsburgs. Of course, similar findings are visible in other art forms, including myriad paintings in the Habsburg Portrait Gallery within the Upper Castle Ambras in Innsbruck. Prognathism is also obvious in Velázquez’s portrait of Philip V in the National Gallery, London, as well as in Joachim Dreschler’s sculpture of King Charles V (also extremely affected), and Albrecht Dürer’s painting of Maximilian I, both housed in the Kunsthistorisches Museum in Vienna.2 Mandibular prognathism is not always as compelling in paintings, perhaps because coins (unlike paintings) almost invariably show profiles. The severity of prognathism varied among different Habsburg members and generations. Given the extensive royal inbreeding one might have anticipated recessive inheritance, but analyses of the afflicted Habsburgs over numerous generations across several hundred years is suggestive of an autosomal dominant trait with variable penetrance, likely influenced by other genes or even homozygosity for the dominant disease allele.3 Indeed, Leopold’s parents Ferdinand III and Maria Anna, who were first cousins, may have both been affected, and Leopold’s ancestral lineage was replete with other consanguineous marriages.1,3

It is thus not surprising that the Habsburgs sustained genetic anomalies, certainly extending well beyond mandibular prognathism. More unexpectedly, clearly visible facial anomalies did not seem troubling to them, since the ruling Habsburgs could have easily ensured that these were not emphasized on contemporary coins and paintings. Alas, centuries of inbreeding eventually caught up to the Habsbugs, and severely-afflicted Spanish king Carlos II was unable to produce an heir before dying young, passing the Spanish throne to the Bourbons.1 The Austrian/German line persisted, and Leopold I produced Joseph I as his heir. As the line later became more outbred, the ‘Habsburg jaw’ largely faded.

CRAIG BLACKSTONE, MD, PhD is Neurologist and Senior Investigator in the Neurogenetics Branch of the National Institute of Neurological Disorders and Stroke, US National Institutes of Health as well as Vice President of the American Neurological Association. He has a special interest in the intersection of numismatics and medicine and is a Life Member of the American Numismatic Association and Life Associate and Augustus B. Sage Society Member, American Numismatic Society.